An Important Day.

Writing this post isn't easy. As you'll hear is a general theme for me, it can be hard to open up and admit your life isn't perfect. Mine certainly isn't... it's far from it. And I'm as far from a good patient sometimes as I can be.
That being said, today was an important day for me. Today was my first endocrinologist appointment since August 2014. Yes, you read that right. It's been two and a half years since I have seen a doctor for my condition. My last endocrinologist appointment ended in tears. I waited months to see a doctor, only to be berated for my 7.0% A1C and for not having seen a doctor in the last 6 months (I lived in a different state for college and I waited 3 months to see that doctor). My endocrinologist made my cry, told me I was a terrible patient, and forgot to prescribe me insulin. I never went back to her. It was the following month that I aged out of the Medicaid system. Paying out of pocket for a speciality doctor was expensive, insulin is more than $200 a bottle, and the school insurance, which didn't cover a great deal of the medications I needed at all, was so expensive that I'd have had to take a second, private loan out just to pay for it because it exceeded the amount of federal loans that I could take out (school is expensive, just fyi). So... I decided to just use the insulin I had saved up from the past few years. My pediatric endocrinologist always let me fill the maximum prescription I could, and it was thanks to her that I had enough insulin saved up from the years to last on. I just handled it all with self management... I've always been a pretty compliant diabetic.
Yes, I understand that some people might read that and say, "well if your health was really a priority. You'd have just taken out the loans and gotten the school insurance." And I understand that. I guess I just figured that I'd be okay to use what I had and keep doing what I'd always done. Maybe I didn't prioritize enough. Maybe I should have spent the thousands to better care for myself. Villianize me or no, I just didn't want to take out all of that money in extra loans. Doctors are great, and doctors are there for you. If you have the right insurance and you can afford it.  I figured that if I worked hard, I would be fine. I always knew that getting through graduate school would be a long haul and a dry spell of very little to no health care. But I ate healthy for a diabetic, stuck to my sugar free diet, and was sure to take my insulin every day. I kept my A1C below a 7 at least, which is all I could hope for for not being under the care of a doctor, I suppose.

Fast forward time. I opened the fridge after getting back from Europe. My insulin stash used to fill an entire fridge drawer, a shelf, and a butter compartment. It barely took up a corner now. I'd calculated how much insulin I would have to last me when I started graduate school, and I had calculated (roughly) enough to last me until May. I guess I had forgotten that I would need to account for waiting until August when I actually passed the boards and got a job with insurance. I didn't have enough to last me that long. I had finally bent and taken out the loans to get the school insurance this semester, and I had made an appointment back in November for the soonest I could be seen (February). So I waited the long haul until then. I had, honestly, begun to have a lot of problems. For starters, I had a lot of personal problems going on that led me to be a stressed/upset the last semester. And I had burnout... bad. For those that don't know much about burnout: basically, there just comes points in your life when you get really damn tired. Please, set your judgement aside before you think of me poorly for that. I don't really know any diabetics it hasn't happened to, I just didn't ever consider it would happen to me. But damn, if I wasn't tired. Tired of this disease taking its toll on me day in, day out. Controlling so many aspects of my life. I hated it. And so I became lax on my treatment. For seconds, I found myself giving the right amount of insulin for my food sometimes, only to have my blood sugar still be high afterwards with no clue as to why. Was it because it wasn't as potent? My insulin by now had all expired. It wasn't cloudy, but I'm sure it was less potent. I just wasn't doing great with my care, in short.
So, this morning I woke up, full of fear and apprehension that I would get yelled at for my bad blood sugar control - full of hope that I could get more insulin and perhaps not struggle these years as much as I had - and I made the drive to Emory to see the endocrinologist. I filled out paperwork and found myself waiting in the treatment room, a place I often sat in the rolling stool of myself at clinic seeing my own patients, but a place that perhaps I was never at as a patient enough. I felt a special kind of shame, being in the health care field and knowing I should take good care of myself but having failed to do so. I stripped away as much pride as I could. Part of me was worried that this endocrinologist visit would be as bad as the last one.
The doctor walked in, an older man. I hadn't been sure who to expect.
I told him how long it had been since I'd seen an endo. "Well, are you doing ok?" He asked.
"I guess...." I said, overwhelmed by all of the things I felt I couldn't express. How hard and sort of heartbreakingly difficult the last 2.5 years had been. How frustrating the health care system was. How tired I was. My meter ended up in his hand, and he flipped through my awful numbers. "I wouldn't call this ok," he said sternly. I felt ready to cry. This was going to be my last endo appointment all over again. I would have to try and find a new doctor again. I hated this. He left the room to try and get my glucose log downloaded from my cheap glucometer. I burst into tears with my husband in the room, who had sweetly come for emotional support. I hated this disease. I hated everything about it. The doctor came back to me blowing my nose into tissues. I told him the truth: I didn't have health insurance. I hadn't since I started school. I was using insulin that had been expired for 2 years. He asked me what I did. I told him I was in my last semester of PT school. "You're good, then." He typed some info into the computer. "Your job," he said, "Is to graduate, and get a job. And then get health insurance. And never let it go. And you'll be golden. Now don't be like that about this. It's going to be okay." He left while I tried to dry my eyes, and came back with his arms full of insulin samples and a new glucose meter. "This should last you a little while."
He gave me some advice about my injection sites (I wasn't rotating sites enough and the absorption was likely poor where I was injecting - try switching my sites even more and that should help me actually have the numbers to show good control when I give the right amount of insulin for my meals). And he told me that I should be on the pump.
I looked at him. "I... I don't want to be on the pump," I told him. "I really don't." He shook his head. "It's always women that say no to that," he looked at Kris as he replied. He didn't push it any further though. He had me set an appointment up with the dietitian 3 months from today and told me to try his advice. "Your job, is to take care of yourself as perfectly as you can for the next 5 years. Listen, I've never actually been able to say this before - it's always just been talk. But it's a good time to be alive. Changes are coming... and it's going to be much easier to manage this disease in 5 years. There will be closed loop systems. You're 23. Keep yourself perfect, and your life will be much easier in 5 years. It's going to be okay," he told me again. "You had a bad few years, but you're my patient now. Next time you come in - you'll be perfect."

I hoped so. My ears burned a little from the sternness I knew I deserved, but for the first time in a long time - my hands were full of samples and my heart (or pancreas?) full of hope. I had started the appointment ready to bolt out of there, but ended it actually really trusting my new doctor and actually really respecting him. I hope that this is a new leaf for me - and an end to the struggles of the last few years. I left feeling more inspired to control my blood sugars than I had in a long time. I think my burnout has officially ended, and I feel ready to work hard again. Today was a big step for me. I look back on the last few years with frustration. It's hard, being a diabetic with no health insurance. Using insulin and praying all the time you have enough to last you until you graduate and get a job with health insurance. It's hard feeling as though you're alone with a disease you never wanted. Diabetes is hard... which is why I always try to be understanding with my own patients. It's hard mentally, physically, financially. In every way. I hope today was an end to some of those especially hard times for me. Even if it just means having a little extra insulin to make it through, or a helping hand to give me advice about controlling my levels better. There's light at the end of the tunnel, and these difficult past few years? They're almost over. They're finally almost over.